What is Endometriosis?
Endometriosis is a common, long-term condition where tissue similar to the lining inside your uterus (called the endometrium) grows outside the uterus — often on the ovaries, fallopian tubes, the lining of the pelvis, or other areas. This tissue reacts to your monthly hormones, causing inflammation, pain, and sometimes scar tissue (adhesions) that can stick organs together. It’s driven by estrogen, so it mainly affects women during their reproductive years, but symptoms can linger or appear even after menopause. Not everyone has symptoms — some women discover it only when trying to conceive.
How Common Is It?
Exact numbers are hard to pin down, but it’s thought to affect 2–10% of women in general. Among women struggling with infertility, the figure can be as high as 30–50%. That means millions of women worldwide live with it, often facing years of pain, fatigue, and challenges with daily life, work, relationships, and mental health.
Who Gets It and Why?
The exact cause isn’t fully understood, but it’s likely a mix of genetics, immune system factors, and environment. One popular theory is “retrograde menstruation” — where some menstrual blood flows backward through the fallopian tubes into the pelvis instead of leaving the body. Family history increases your risk (if your mum or sister has it, you’re more likely to). Other factors include starting periods early, short cycles, or certain congenital issues with the reproductive tract. There’s no proven way to prevent it, though a healthy lifestyle is always good for overall well-being.
What Does It Feel Like?
Symptoms vary hugely from woman to woman. Common ones include:
- Very painful periods (dysmenorrhea)
- Pelvic pain at other times of the month
- Pain during or after sex
- Pain when peeing or pooping
- Fatigue and exhaustion
- Difficulty getting pregnant
- Sometimes cyclical issues like shoulder pain, chest problems, or pain in scars
Symptoms are often worse around your period. In teens, it might show up as severe cramps that stop you going to school or needing the pill early for pain relief. Importantly, you can have endometriosis without any symptoms, or symptoms that don’t match the severity seen on scans or surgery.
How Is It Diagnosed?
Your doctor will listen carefully to your symptoms and may do a pelvic exam to feel for nodules or tenderness. Ultrasound or MRI scans can help spot larger cysts (endometriomas) or deep endometriosis, but they often miss smaller patches.
Blood tests (like CA-125) aren’t reliable for diagnosis. A laparoscopy (keyhole surgery) used to be the “gold standard,” but it’s no longer needed for everyone — especially if symptoms improve with treatment. Doctors can start treatment based on your story alone (this is called empirical treatment). If things don’t improve, surgery may be offered for both diagnosis and relief.
Treatment Options
The goal is to ease pain, improve quality of life, and support fertility when that’s important to you. Treatment is very individual — what works for one woman may not suit another. Always discuss pros, cons, and your plans (like wanting children) with your doctor.
First-line treatments (where most women start):
- Pain relief: Simple anti-inflammatories like ibuprofen (NSAIDs) — great for period pain.
- Hormonal options: The combined pill, patch, or ring (often used continuously to skip periods), or progestogen-only methods like the hormonal coil (Mirena/LNG-IUS), pill, or implant. These help by lowering estrogen and reducing bleeding and inflammation.
For teenagers, similar options are used carefully.
Second-line treatments:
If first options aren’t enough:
- Stronger hormonal drugs called GnRH agonists or antagonists (these create a temporary menopause-like state — often with “add-back” hormone therapy to protect bones and reduce side effects).
- Surgery (usually laparoscopic) to remove or destroy visible endometriosis. This can help pain and fertility in milder cases. After surgery, hormonal treatment is often recommended to prevent symptoms returning (unless you’re trying to get pregnant soon).
Third-line and beyond:
For persistent or severe cases:
- Other medications like aromatase inhibitors (usually combined with other hormones).
- More complex surgery at specialist centres, especially for deep endometriosis affecting bowel or bladder.
- In some cases where fertility isn’t a concern and symptoms are very bad, hysterectomy (removal of the uterus) ± ovaries may be discussed.
Long-term management often involves staying on hormonal treatment to keep symptoms under control and reduce recurrence. Many women also benefit from support like physiotherapy, counselling, or joining patient groups.
Endometriosis is a chronic condition, but with the right support and treatment, most women can manage their symptoms and live full lives. If you suspect you have it, don’t suffer in silence — speak to your GP and ask about endometriosis. Early help can make a big difference.
This is a plain-language summary based on the 2022 ESHRE guideline. Always consult your own doctor for personalised advice, as guidelines evolve and individual situations differ.
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